For Older Adults, High Risk of Death While Waiting for a Kidney

Projections suggest that close to half of patients aged 60 or older currently on the waiting list for kidney transplantation will die before receiving a cadaver organ, according to a study in the Clinical Journal of the American Society of Nephrology.

The investigators reviewed national registry data on transplant patients including nearly 55,000 patients over age 60 who were listed for a single-kidney transplant from 1995 to 2007. Survival models suggested that 46 percent of over-60 patients wait-listed in 2006 or 2007 would die before undergoing deceased donor kidney transplantation.

For certain groups of patients, the risks of dying without a transplant were even higher, including rates of 62 percent for African Americans, 61 percent for diabetics, and 52 percent for patients aged 70 or older. Risk was 71 percent for patients with blood type B and 60 percent for those with type O, 68 percent for highly sensitized patients, and 52 percent for those on dialysis at wait-listing. By UNOS region, the risk of dying on the waiting list varied from 6 percent (region 6) to 81 percent (region 5).

The increase in waiting times to deceased donor transplantation has a particularly large impact on older patients. The risk of dying before receiving a kidney transplant is high for patients over 60 and varies between regions. Disseminated to patients, this information could have an important impact on decision-making, including the decision to seek a living donor [Schold JD, Srinivas TR, Sehgal AR, Meier-Kreische HU: Half of kidney transplant candidates over the age of sixty now wait listed will die prior to receiving a deceased donor transplant. Clin J Am Soc Nephrology 2009; 4:1239–1245].